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PubMedDate not supplied

Thoracoscopic lung resection by the help of Nd:YAG laser.

The Swedish surgeon Jacobaeus was the first to use a lighted cystoscope for the lysis of pleural adhesions /5/. The same author reported, in 1921, five cases of intrathoracic malignancies diagnosed by thoracoscopy /6/. After the appearance of video-assisted cholecystectomy and abdominal surgery, video-assisted thoracic surgery (VATS) also occupied a major share in thoracic surgery. It was long ago that we introduced a thoracoscope (not the video-assisted type) for thoracic intervention. In 1988 we published 24 cases of thoracic sympathectomies in which we used the thoracoscope /16/.

Endoscopes↗
PubMed1996

Thoracoscopic lung resection for lung metastasis of colorectal cancer.

We performed thoracoscopic lung resection seven times in four patients with lung metastases from colorectal cancer. This procedure allowed a short operation time, minimal blood loss, and a short hospital stay. Thoracoscopic lung resection was chosen for resection of lung metastases from colorectal cancer because it allowed simultaneous bilateral lung resection and early postoperative adjuvant chemotherapy.

Adult↗
PubMedDate not supplied

Thoracoscopic limited resection of bronchogenic carcinoma in patients over the age of 80.

Video-assisted thoracoscopic surgery (VATS) has emerged as a minimally invasive therapy of bronchogenic carcinoma, when the diseases occur in patients unable to tolerate open thoracotomy who are 80 years old or older. We report on an 80-year-old man with poor pulmonary function and an 83-year-old man, who were treated with a complete VATS resection of bronchogenic carcinoma. Mean chest tube duration of the two patients was one day and mean postoperative hospital stay was 7 days with an uncomplicated postoperative course. Compared with patients with open thoracotomy, there were early mobility, less morbidity, and less mortality. We believe that when the indication for treatment of bronchogenic carcinoma in patients over the age of 80 with concomitant systemic disorders, a thoracoscopic limited resection should be considered.

Aged↗
PubMed1997

Video-assisted thoracoscopic truncal vagotomy.

Thoracoscopic truncal vagotomy was performed in three patients with recurrent ulcer after previous Billroth-II gastrectomy. The technique involved double-lumen endotracheal-endobronchial intubation and single-lung ventilation. No morbidity or mortality existed and the mean hospitalization was 7 days. To date, no recurrent ulceration has been detected in these patients. Thoracoscopic truncal vagotomy is considered to be a rapid, simple and safe approach and thus could play a preferential role in the management of patients with recurrent peptic ulcer after previous gastrectomy.

Aged↗
PubMed1997

Thoracoscopic surgery of the oesophagus in rats: a training concept for the treatment of tracheo-oesophageal malformations in preterm infants.

In extremely preterm babies with type Vogt III b oesophageal atresia, the primary operative management can be restricted to a gastrostomy and ligation of the fistula. Some of these patients, however, may not even tolerate a thoracotomy or placement on the operating table. We developed a minimally invasive procedure to prepare and ligate the oesophagus thoracoscopically and perform laparoscopic gastrostomy in a rat model. In 15 operations we observed only one complication. This study implies that after adequate practice, thoracoscopic dissection of the oesophagus with ligation of a tracheo-oesophageal fistula could be performed even in every small infants.

Animals↗
PubMedDate not supplied

[Thoracic sympathectomy via the thoracoscopic approach. The operative technic].

The authors describe the technique of thoracic sympathectomy by thoracoscopic approach in the variant in which the sympathetic chain is divided between T4 and T5 sympathetic ganglion associated with the division of the gray and white rami communicantes of the T2-T3-T4 sympathetic ganglions. The article emphasizes the importance of the 2nd sympathetic ganglion in the regulation of the blood circulation of the arm and the advantages of the thoracoscopic approach for this type of intervention.

Adult↗
PubMed1997

Thoracoscopic spinal surgery. Treatment of thoracic instability.

Thoracoscopic spinal surgery is technically feasible and can be performed safely with acceptable rates of morbidity and excellent clinical and neurologic results. Thoracoscopic techniques can be used for anterior decompression and internal fixation in cases in which pathologic processes lead to instability. This minimally incisional access technique can achieve the identical extent of spinal exposure, dissection, decompression, and reconstruction as those obtained with open techniques.

Adolescent↗
PubMed1997

[Video-assisted thoracoscopic surgery--indications, technique and results].

Video-assisted thoracoscopic surgery became an important tool in the surgical treatment of various thoracic disease. Currently many interventions which routinely required thoracotomy can be performed by VATS safely and with excellent results. This includes pleurectomy, decortication, wedge-resection, bullectomy and volume reduction surgery for emphysema, biopsy and/or resection of mediastinal tumors, thymectomy for myasthenia gravis, sympathectomy and even lobectomy. The benefit of thoracoscopic surgery is reduced postoperative pain, including diminished impairment of pulmonary function, shorter hospital stay and the more rapid recovery.

Anesthesia, General↗
PubMed1998

[Abdomino-thoracoscopic esophagus resection--an animal experiment study].

Based on animal trials the presented study results describe a method of abdomino-thoracoscopic oesophagectomy for the treatment of oesophageal carcinoma of the middle and lower third. Technical details and the advantages of the surgical procedure, including the avoidance of thoracotomy and the practicability of the thoracoscopic dissection of the oesophagus are shown. Problems exist in the salvage of the specimen, especially in the transcervical passage of the tumorbearing oesophageal part. A final evaluation of the importance of the minimally invasive techniques in oesophageal surgery should not be given until the results of clinical studies are available.

Anastomosis, Surgical↗
PubMed1998

[Dorsal sympathectomy for palmar hyperhidrosis by the thin thoracoscope].

The purpose of this study was to examine the efficiency to use by the thin thoracoscope for the palmar hyperhidrosis. General anesthesia with double lumen endotracheal intubation was used in all cases. A 2 mm incision made in the anterior axillary line in the third intercostal space. Pneumothorax was obtained by insufflation 1.5-2 L of CO2. A 2 mm endoscopic trocar was inserted through this incision, and a 2 mm, 0-degree scope (Autosuture, USA) was introduced. A second 2 mm trocar was inserted in the middle axillary line in the fourth intercostal space, through which a straight endoscopic seizer was introduced. The chain was dissected by electrocutting the white and gray rami and was incised over the second and third ribs. To avoid puemothorax, 8 F thoracic catheter was introduced through a guide wire which was inserted through a 2 mm trocar. The lung was expanded, and then the thoracic catheter was removed. We performed six sympathectomies on three female patients. All patients was satisfied of their results. This technique used by thin thoracoscope was cosmetic and a skin incision did not need to close too small.

Endoscopy↗
PubMed2000

Thoracoscopic splanchnicectomy for pain relief in unresectable pancreatic cancer.

HYPOTHESIS: Unilateral truncal thoracoscopic splanchnicectomy (TS) provides safe and effective treatment for pain relief in patients with unresectable pancreatic cancer. DESIGN: Before-and-after trial of 24 patients undergoing 25 TS procedures. SETTING: Surgical unit at a university teaching hospital. PATIENTS: A consecutive sample of 24 patients with severe pain due to unresectable (primary or recurrent) pancreatic cancer refractory to drug therapy and with a life expectancy of less than 6 months. INTERVENTION: The key point of the reported operation is intrathoracic carbon dioxide insufflation, which allows a more distal division of the greater splanchnic nerve and a 2-port technique. MAIN OUTCOME MEASURES: Pain and the effect of this symptom on quality of life were assessed before and after TS using a 10-point visual analog pain scale (VAS) and the Nottingham Health Profile questionnaire, respectively. RESULTS: Four TS procedures were technical failures because of pleural adhesions. One patient required a contralateral procedure 12 weeks after TS. Mean (+/- SD) preoperative VAS basal score was 7.4 +/- 1.7. Twenty-four hours after TS, it was reduced to 0.6 +/- 1.0. Significant reduction of VAS scores persisted over the first 3 months after TS (P<.001). Recurrence of pain of low intensity (mean VAS basal score, 4.2) was observed in 8 patients. Significant improvement (P<.001) in each area covered by the Nottingham Health Profile questionnaire was reported at 1 month after TS. CONCLUSION: Thoracoscopic splanchnicectomy offered substantial short-term relief of pain in patients with unresectable pancreatic cancer, and significantly ameliorated the quality of their residual life.

Aged↗
PubMed1994

Thoracoscopic partial lung resection in patients with severe chronic obstructive pulmonary disease. A preliminary report.

OBJECTIVE: To determine if patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection. DESIGN: Patients with non-small-cell lung cancers were selected from 583 cases undergoing laser treatment. The parameters studied included sex, age, tumor size, spirometry (forced vital capacity, forced expiratory volume in 1 second), operating time, operative mortality rate, postoperative ventilatory time, and length of hospital stay. The follow-up period varied from 4 to 30 months. SETTING: A private community hospital with nationwide referrals. PATIENTS: Nine consecutive patients (five men, four women) were found to have lung cancer before (four patients) or at (five patients) surgery. Their mean (+/- SD) age was 71.2 +/- 3.8 years; tumor size, 3.3 +/- 1.6 cm; forced vital capacity, 2.04 +/- 0.50 L (49.7% +/- 10.2%); and forced expiratory volume in 1 second, 0.66 +/- 0.11 L (22.2% +/- 5.5%). INTERVENTIONS: With patients under general anesthesia with one-lung ventilation, the tumor was resected and coexisting diffuse bullae were treated by a contact neodymium:YAG laser. Four patients received adjuvant therapies: chemotherapy, one; radiation and chemotherapy, one; radiation, one; and brachytherapy, one. MAIN OUTCOMES: All patients tolerated surgery; there were no deaths. Mean (+/- SD) operating time was 4.9 +/- 1.4 hours; postoperative ventilatory time, 10.3 +/- 6.8 hours; and length of hospital stay, 15.2 +/- 13.2 days. RESULTS: One patient died of disease progression 4 months after surgery. There was one local recurrence and one distant metastasis. Four patients remained free of tumors. CONCLUSIONS: Patients with severe chronic obstructive pulmonary disease can tolerate thoracoscopic partial lung resection but an effort should be made to reduce local recurrence.

Aged↗
PubMed1998

Vasomotor and sudomotor function in the hand after thoracoscopic transection of the sympathetic chain: implications for choice of therapeutic strategy.

The degree of sympatholysis achieved by thoracoscopic transection of the sympathetic chain (sympathicotomy) was evaluated by measuring sudo- and vasomotor function in the hands before and after surgery in 12 patients with palmar hyperhidrosis. Our results show a marked reduction in sweat production and a cutaneous vasodilatation which remained unchanged during the 6 months follow-up, whereas sudo- and vasomotor reflexes normalized within this time. Skin temperature variations did not correlate to skin perfusion changes. Since all subjects reported dry and warm hands throughout the follow-up period, our results indicate that recording reflex responses to sympathoexcitatory stimuli does not adequately reflect clinical outcome of subtotal sympatholytic procedures performed for hyperhidrosis. Monitoring of clinical outcome should therefore include measurement of baseline sweat production and skin perfusion. However, the normalized reflex responses highlight the incomplete sympatholysis achieved by thoracoscopic sympathicotomy, which may be beneficial in some pathological conditions (such as hyperhidrosis) but detrimental in others.

Adrenergic Fibers↗
PubMedDate not supplied

Thoracoscopic esophagectomy: are there benefits?

Between 1991 and 1995, 18 patients affected by a resectable intramural tumor of the esophagus underwent esophagectomy with thoracoscopic dissection of the esophagus. All patients had a relative contraindication to transthoracic esophagectomy with radical lymphadenectomy. All esophagectomies were completed thoracoscopically and reconstruction of the digestive tract was performed in 17 cases through cervical gastroplasty, and in 1 case, through cervical coloplasty. One cirrhotic patient died in the postoperative period due to a cervical anastomotic leak. Six other patients experienced a postoperative complication (mortality rate, 5.5%; morbidity rate, 33.3%). After a median follow-up of 17 months, 14 patients are alive without evidence of disease. One patient, who had excision of a cutaneous metastasis at a trocar insertion site 6 months postoperatively, eventually died with locoregional recurrence 14 months postoperatively. Another patient died 20 months after surgery with mediastinal recurrence. One patient died 28 months postoperatively after massive hematemesis with a suspect abdominal recurrence. The results of the present series, and those reported by other authors, do not seem to indicate evident advantages at present for the minimally invasive procedure during resection of the esophagus for cancer. Currently, there is no indication that this procedure should be used for standard clinical use. Wider randomized trials, performed in selected centers only, and longer follow-up are needed to further evaluate the procedure.

Aged↗
PubMed1992

Thoracoscopic neodymium: yttrium aluminum garnet laser resection of a pulmonary metastasis.

BACKGROUND: Patients with a history of malignant disease and new pulmonary lesions often are considered for resection to establish a diagnosis and, with certain histologic subtypes, to improve survival. Standard operative therapy consists of thoracotomy and wedge resection of the lesion. Early and late postoperative morbidity is substantial and related primarily to the thoracotomy incision. METHODS: Advances in endoscopic surgical techniques and laser technology allowed for successful thoracoscopic resection of an isolated pulmonary metastasis in a 59-year-old man with a history of a T3N0M0 renal cell carcinoma. RESULTS: The margins of the specimen were free of tumor. The postoperative course was uncomplicated, and the patient was discharged on the fourth postoperative day. The morbidity associated with a standard thoracotomy was avoided, and an adequate resection was obtained. CONCLUSION: Continued success with thoracoscopic resection may have a significant impact on the management of selected patients with a history of malignant disease and new pulmonary lesions.

Aluminum↗
PubMed1992

Thoracoscopic long oesophageal myotomy for nutcracker oesophagus: initial experience of a new surgical approach.

A thoracoscopic technique is described for the execution of long oesophageal myotomy for nutcracker oesophagus causing odynophagia and non-cardiac chest pain. The technique is based on a multipuncture method and a left thoracoscopic approach. It has been performed on three patients with complete symptomatic relief in the short term, although the follow-up period is short (maximum 12 months). No complications were encountered and discharge from hospital occurred by the fifth day after operation.

Adult↗
PubMed1997

Combination of high-dose chemotherapy, autologous bone marrow/peripheral blood stem cell transplantation, and thoracoscopic surgery in refractory nongestational choriocarcinoma of a 45XO/46XY female: a case report.

A 39-year-old woman having a pure gonadal choriocarcinoma with lung metastasis was referred to our hospital after hysterectomy and bilateral salpingo-oophorectomy. She was found to have a 45XO/46XY karyotype and gonadal dysgenesis. The patient's serum beta-hCG was normalized after six courses of chemotherapy with cisplatin and etoposide of conventional dose (100 mg/m2, 100 mg/m2 x 3 days), but began to fluctuate. Thoracoscopic resection of a remaining pleural lesion was negative for malignancy. However, the disease relapsed as multiple metastatic nodules in bilateral lung fields and the mediastinum. After one course of priming chemotherapy with conventional dose (1 g/m2 cyclophosphamide, 400 mg/m2 carboplatin, and 500 mg/m2 etoposide), high-dose chemotherapy with a total dose of 1500 mg/m2 carboplatin, 1200 mg/m2 etoposide, and 5 g/m2 ifosfamide followed by autologous bone marrow transplantation and peripheral stem cell support was given. Thoracoscopic surgery was performed to resect two residual solitary metastatic lung lesions. With these salvage treatments, the patient obtained complete remission and remained disease free at last follow-up (17 months). Our result suggests that high-dose chemotherapy may be effective in chemosensitive nongestational choriocarcinoma when first chemotherapy has failed.

Adult↗
PubMed1996

CT-guided needle localization of lung nodules for thoracoscopic resection.

We used CT to guide positioning of hookwires within 19 lung nodules in order to localize them prior to thoracoscopic surgery. Both Hawkins III and Kopans-type needles with internal hookwires were employed. Nodule diameter ranged between 0.7 and 4 cm (mean 1.7 cm), and depth from the site of entry of the needle into the pleural surface ranged from 0.5 to 8 cm. Needles were advanced using a technique identical to that for CT-guided biopsy, and localization proved successful in 18 of 19 cases. During surgery, dislodgement of the guidewire occurred in 5 cases, probably due to traction manoeuvers on it. In all these cases the hook of the wire had been opened within the nodule. No dislodgement occurred in patients in whom the needle had been advanced beyond the nodule and the hook allowed to open in the pulmonary parenchyma deep to it. Severe complications did not occur: there was moderate pleuritic pain in 16 cases and asymptomatic pneumothorax in 13 patients. Computer-tomography-guided needle localization of lung nodules is a safe and relatively easy procedure that allows thoracoscopic surgery of lesions which otherwise might be impossible to locate and resect.

Adult↗